The fate of cryopreserved sperm acquired during vasectomy reversals

Purpose: Intraoperative sperm banking has been recommended during vasectomy reversal. These specimens are maintained as insurance for possible future intracytoplasmic sperm injection. We evaluated the fate of specimens collec ted intraoperatively from 48 vasectomy reversal patients. Materials and Methods: Of 75 men 48 (64.0%) agreed to intraoperative sperm banking during vasectomy reversal. A total of 135 vials of epididymal sperm , 81 vials of testicular tissue and 13 vials of vasal sperm were cryopreser ved. Results: Among couples who stored sperm 10 (20.8%) voluntarily discarded th e specimens within 4 months of vasectomy reversal. Specimens from 31 couple s (64.5%) remain in storage. Seven couples (14.6%) have used frozen sperm f or intracytoplasmic sperm injection. In 3 of these couples the men were azo ospermic after surgery, 2 men had 10,000 to 15,000 sperm per mi. in the eja culate with limited motility and 2 had 1 to 2 million sperm per mi. with li mited motility. The 7 women who underwent intracytoplasmic sperm injection ranged between 37 and 39 years old, which was older than the mean age of th e remaining study group (32.7 years). With intracytoplasmic sperm injection fertilization was achieved in all cases and 20 of 47 eggs (42.5%) develope d into embryos. Of 7 women 4 achieved biochemical pregnancies (57.1%) and 2 (28.6%) delivered newborns with epididymal sperm. Natural pregnancy occurr ed in 7 of 16 vasectomy reversal couples (43.7%) who were followed at least 18 months postoperatively but the time to pregnancy averaged 1 year. Conclusions: Cryopreservation of sperm collected at vasectomy reversal is r ecommended for patients undergoing vasoepididymostomy or vasovasostomy. The couples who used the cryopreserved sperm for intracytoplasmic sperm inject ion included husbands whose postoperative ejaculate remained azoospermic or severely oligospermic and wives who were approaching 40 years old. Only a limited number of couples (14.6% of the study group) have used the cryopres erved sperm but the delivered newborn rate (28.6%) was comparable to other intracytoplasmic sperm injection data. The natural pregnancy rate after vas ectomy reversal was 43.7% but the time to pregnancy after surgery was lengt hy (average 1 year). These findings may be helpful for counseling couples w ho are planning vasectomy reversal surgery and may be considering intraoper ative sperm banking.